Surgeons' Lounge: Conversation With L. Michael Brunt, MD

The Future of Surgery Is Less Invasive

L. Michael Brunt, MD, president of the Society of American Gastrointestinal and Endoscopic Surgeons, is chief of the section of minimally invasive surgery in the department of surgery at Washington University School of Medicine in St. Louis.

Conversation With L. Michael Brunt, MDThe Future of Surgery Is Less Invasive

What's the future of minimally invasive surgery?We still haven't moved the needle far enough in terms of patients being offered minimally invasive approaches for a variety of conditions. Not every patient is a candidate for a laparoscopic procedure, but we know that the rate of lap colon resection is not at the level that it could be.

What innovations are you excited about?Enhanced imaging makes everything we do easier and safer. One of the biggest areas of future development will involve doing more therapeutic procedures with an endoscope. And more procedures will be done through natural orifices.

As techniques evolve, there has to be a focus on patient safety. Technology is great, but it has to be safe.Absolutely. It has to be safe for patients, but it also has to be cost effective. We can no longer add the cost of new procedures unless we're also adding value to patient outcomes, to faster returns to activity, work and productivity.

What accomplishments are you proudest of during your tenure as SAGES president?Patient safety is one of the themes of my presidential year. Last summer we rolled out the Fundamental Use of Surgical Energy (FUSE) program (tinyurl.com/l7dhx2q), which is a free web-based didactic educational program available to any surgeon or health provider. It addresses a huge gap in surgical education aimed at reducing injuries related to the use of surgical energy devices. It's a huge initiative that's garnering a large amount of attention and interest worldwide.

Is enough being done to enhance lap surgery safety?This is something I'm really passionate about. Even though it's been a quarter-century since lap cholecystectomy began the minimally invasive era, we're still seeing issues with bile duct injuries.

How big is the problem?The incidence has not gone down  approximately 3,000 injuries occur each year. At my direction, SAGES initiated a 6-step safe cholecystectomy program (tinyurl.com/kghfvzy) to better educate surgeons about strategies for reducing biliary injuries and other complications from cholecystectomy, which at approximately 750,000 surgeries each year, is the most common procedure done by general surgeons.

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